Exploring the Potential Role of Upper Abdominal Peritonectomy in Advanced Ovarian Cancer Cytoreductive Surgery Using Explainable Artificial Intelligence

Abstract

The Surgical Complexity Score (SCS) has been widely used to reflect the surgical effort during advanced stage epithelial ovarian cancer (EOC) cytoreduction. However, not all surgical procedures are described by this score. Using artificial intelligence, we developed and explained an algorithm that weighted the importance of all surgical procedures for the prediction of complete cytoreduction (CC0). We identified upper abdominal peritonectomy (UAP) as the most salient procedural predictor of CC0, followed by pelvic and para-aortic lymph node dissection and ileocecal resection/right hemicolectomy. The UAP was predictive of poorer progression-free survival but not overall survival. The SCS did not impact survival. We advocate thorough early inspection of the upper abdominal quadrants to ensure that CC0 is achievable.